Urology-Online

Phimosis surgery

introduction

In the Phimosis it can happen that the Foreskin constriction does not regress by itself. Treatment with oils etc. is also sometimes not promising. Then an operation is always necessary.

Since the constriction often regresses by itself by pre-school age, this is also the point in time at which a possible surgical procedure must most likely be considered. In doing so, as part of the so-called Circumcision or clippingwho have removed the tightness. This procedure is quick and can usually be carried out on an outpatient basis.

Indication for surgery

Up to the 2nd year of life a phimosis is considered normal. Surgery is usually recommended if the tightness causes inflammation, irritation or pain. Can also possibly occur Painful urination represent a reason for the operation.

Furthermore, an operation should be carried out if the phimosis is also present does not go back to preschool by itself has formed. Overall, however, should not waited longer than 8 years of age become. At this age, the phimosis often becomes a psychological burden for the boys concerned.

If the operation is carried out early, the chance that the child will retain very few memories and thus psychological distress from the phimosis is much higher. A OP time around the age of 6 is considered to be advantageous because the child at this age can understand the purpose of the operation, but should not perceive the intervention in the genital area as too stressful.

At least in the case of existing complaints, you should not hesitate too long. Difficulty urinating, may be linked to an eventual Inflammation of the foreskin, the risk for Urinary tract infections greatly increase. The mostly poorer hygiene due to the fact that the foreskin cannot be completely pulled back, favors the formation of inflammatory reactions and ultimately the risk for Penile cancer.

Last but not least, you can also later Difficulty having sexual intercourse occur, e.g. the so-called Paraphimosis. The foreskin, which is too tight, pushes back over the glans, but then forms a kind of constriction ring there, which hinders the flow of blood and the Glans swell leaves. Since the foreskin cannot be pushed back any other way, an acute surgical intervention is necessary. In general, an intervention should not be carried out into an existing inflammation.

In principle, phimosis regresses by the end of the puberty also possible on its own. However, the psychological stresses described above should be weighed here.

Procedure for the operation

Radical Circumcision

The extent of the circumcision depends on the degree of phimosis, but also on the wishes of the parents or the patient. So can the circumcision radical done with the foreskin, similar to religious circumcision rites completely removed becomes.

During the procedure, the foreskin is first loosened from the glans and then tightened with the help of two tweezers. In the next step, both foreskin layers are separated with the help of the scalpel. The inner and outer skin layers are then reconnected with absorbable thread. This usually falls within the first 1-2 weeks.

However, this method is rarely required for medical reasons, but is often chosen if a child with phimosis already has one clipping was planned for religious reasons. You should make sure that the medical reasons are well documented in order to prevent later trouble with the health insurance company.

Extension plastic

If desired, that is the child's foreskin preserved as possible remains, a so-called extension plastic is also possible. However, this procedure is only possible if the Phimosis not too pronounced is.

In doing so, no part of the foreskin is cut off, but rather an enlargement is achieved through skillful incision. For this purpose, the layers of the foreskin are incised in a V-shape or with several cuts and then stitched together again. This increases the diameter and the symptoms disappear.

In this operation it is particularly important that the Foreskin then pulled back daily becomes. This works best as part of a Hip bathe.g. With chamomile.

Plastic Bell Method

Another method is the plastic bell method. This ultimately leads to a partial circumcision.

The foreskin is first incised and spread. Then one can Plastic bell over the glans of the child and tied the edge of the foreskin to it with a thread. This prevents the blood flow to the foreskin edge so that it dies by itself after 8-10 days and together with the plastic bell falls off.

Duration of anesthesia and surgery

The procedure usually only lasts about 15-20 minutes and is usually in a short general anesthesia carried out. this will especially in children handled in such a way that they don't notice as much as possible of the operation.

In adults, instead of general anesthesia, a procedure in Spinal anesthesia or with the help of the so-called Penis blocks possible. Only the nerve fibers that supply the penis directly are used with the help of a Local anesthetic stunned.

Possible complications

In general, the phimosis surgery is one very low-risk procedure. Also the associated one Anesthetic risk is due to very short surgery duration very low.

Of course, as with all operations, complications can arise here too. This is mostly about Secondary bleeding, Wound infections or excessive scarring.

If too small a part of the foreskin has been removed, it is possible that this will continue after the operation phimosis forms again. In total, reoperation is necessary in around 6% of cases.

After the operation

After the operation, the patient should At home for at least 24h under observation to detect any bleeding or other problems early.

In the period immediately after the operation it can become easier Swelling and discoloration of the penis. Pain when urinating is also quite normal. The Pain after the operation can usually be easily sold with Painkillers, how Ibuprofen or Paracetamol get a grip. Easy cooling can help prevent further swelling and also has a pain reliever.

To support wound healing are partial Hip baths recommended with chamomile. In order to prevent the fresh wound from sticking to diapers or underwear, the wound can e.g. with a Panthenol cream be creamed.

Exercise, especially those that are associated with high impact loads, should avoided for about 6 weeks become. In any case, the further healing process must be checked by a doctor. When pain, redness in the area of the wound or fever and feelings of illness occur, you should definitely consult your doctor.

The thin skin of the glans, which is additionally irritated after the operation, can lead to inflammation of the glans. Against this, the aforementioned Sitz baths and wearing further underwear are preventative in order to expose the glans to less mechanical stress.